Life-threatening haematochezia in a man with two gastrointestinal stromal tumours

A man in his 30s was brought by ambulance to the emergency department with a complaint of frank bright red rectal bleeding and dizziness. His blood pressure was 60/18 mm Hg. He was resuscitated with intravenous normal saline and an emergency blood transfusion. Following a negative emergency oesophagogastroduodenoscopy and colonoscopy, an angiographic CT of the abdomen revealed a large tumour in the ileum. After failing to stabilise him with multiple blood transfusions, he had an emergent laparotomy and surgical resection of the tumour, which was confirmed by histocytology as gastrointestinal stromal tumour (GIST). He made full recovery and was discharged home after 10 days. We discussed the challenges of managing significant lower gastrointestinal bleeding and reviewed the current management of GIST.

Intraoperative Cone Beam Computed Tomography of Tracheal Stenting for Stenosis and Fistula Diseases: A Retrospective Cohort Study

Background and objectives: Previous experience has shown that angiographic CT is useful in various medical contexts, but little research has been presented regarding the application of Cone beam Computer Tomography (CBCT) in airway stenting. In this study, we retrospectively evaluated the clinical feasibility of CBCT in airway stent placement by conducting a single-center retrospective cohort study.Methods: A total of 228 patients with stenosis or fistula diseases were treated with metallic airway stents in our hospital from January 1, 2015, to December 31, 2018. CBCT scanning was performed on 100 patients during and after treatment, and the images were compared with those from postoperative CBCT. We also assessed the outcomes and complications in the CBCT-guided and the fluoroscopy-guided group.Results: Tracheal stenting was performed successfully on the first attempt in 90 patients in the CBCT-guided group and 123 patients in the fluoroscopy-guided group. The measured diameters and lengths of the central airway as shown in CBCT were not significantly different from those obtained by MDCT. However, there were significant differences in the visibility of the distal bronchus, pulmonary parenchyma and airway above the upper stent graft; nonetheless, 2 of the 3 anatomical areas were reproduced in a diagnostically relevant way. The rate of major complications was rather low in the CBCT-guided group compared with the fluoroscopy-guided group.Conclusions: CBCT images were proven to have sufficient quality to replace MDCT as a reasonable control measure after stent implantation and reduce the complications of airway stent placement when performed in the operation.